title: beta-Blockade in noncardiac surgery: outcome at all levels of cardiac risk.
abstract: OBJECTIVE
  We hypothesized that the relationship among beta-blocker use, heart rate control, and perioperative cardiovascular outcome would be similar in patients at all levels of cardiac risk.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas.
  
  
  METHODS
  Among all patients who underwent various noncardiac surgical procedures in 2000, those who received perioperative beta-blockers were matched and compared with a control group from the same patient population.
  
  
  METHODS
  Thirty-day stroke, cardiac arrest, myocardial infarction, and mortality, as well as mortality at 1 year.
  
  
  RESULTS
  Patients at all levels of cardiac risk who received beta-blockers had lower preoperative and intraoperative heart rates. The beta-blocker group had higher rates of 30-day myocardial infarction (2.94% vs 0.74%, P =.03) and 30-day mortality (2.52% vs 0.25%, P =.007) compared with the control group. In the beta-blocker group, patients who died perioperatively had significantly higher preoperative heart rate (86 vs 70 beats/min, P =.03). None of the deaths occurred among the patients at high cardiac risk.
  
  
  CONCLUSIONS
  Among patients at all levels of cardiac risk undergoing noncardiac surgery, administration of beta-blockers should achieve adequate heart rate control and should be carefully monitored in patients who are not at high cardiac risk.
authors.affiliation: Department of Surgery, Veterans Affairs Boston Healthcare System (112), 1400 VFW Pkwy, West Roxbury, MA 02132, USA.
authors.forename: Haytham M A
authors.initials: HM
authors.lastname: Kaafarani
authors.forename: Prasad V
authors.initials: PV
authors.lastname: Atluri
authors.forename: John
authors.initials: J
authors.lastname: Thornby
authors.forename: Kamal M F
authors.initials: KM
authors.lastname: Itani
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage*; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006323:Heart Arrest / Q000401:mortality / Q000517:prevention & control; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000517:prevention & control; D019990:Perioperative Care; D011183:Postoperative Complications / Q000517:prevention & control; D011336:Probability; D012016:Reference Values; D012189:Retrospective Studies; D018570:Risk Assessment; D012737:Sex Factors; D020521:Stroke / Q000401:mortality / Q000517:prevention & control; D013514:Surgical Procedures, Operative / Q000379:methods / Q000401:mortality*; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D000319:Adrenergic beta-Antagonists